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Comparison of Clinical and Economic Outcomes of an Optimized Lean Versus a Standard Transcatheter Aortic Valve Implantation Program (from SOLAR [Safe Outcomes Lean And Resourceful] Study)

Published:November 01, 2022DOI:https://doi.org/10.1016/j.amjcard.2022.09.034
      The increasing prevalence of aortic stenosis (AS) and the increasing number of patients indicated for transcatheter aortic valve implantation (TAVI) can lead to increased hospital constraints. This study aimed to compare, from the hospital perspective, the costs, resource use, and 30-day clinical outcomes of patients who underwent TAVI under an optimized or standard clinical pathway. A single-center, retrospective study was conducted among patients with native AS who underwent TAVI between January 2018 and March 2021. Patients who underwent optimized lean TAVI were propensity-score matched 1:1 to those who underwent standard TAVI. In-hospital costs and 30-day clinical outcomes were compared between the 2 groups. A total of 182 patients (91 in each group) were included in the final analysis. Baseline covariates were well balanced after matching. Patients who underwent lean TAVI had shorter length of stay (median [interquartile range] 3.0 days [2.0 to 6.0] vs 6.0 days [5.0 to 9.0], p <0.001). Patients in the lean TAVI group incurred lower total costs than did those in the standard TAVI group (mean ± SD: $41,346 ± 10,062 vs $50,471 ± 15,115, p = 0.002). There was no between-group difference in 30-day all-cause mortality (2.2% vs 1.1%, p = 0.573) and pacemaker implantations (5.5% vs 6.6%, p = 0.788). Rates of procedural complications were comparable between groups. In conclusion, lean TAVI leads to hospital efficiencies without compromising patient safety. Efforts to streamline the TAVI procedure should be encouraged to improve access to TAVI for patients with AS, amid resource constraints.
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      References

        • Vahanian A
        • Beyersdorf F
        • Praz F
        • Milojevic M
        • Baldus S
        • Bauersachs J
        • Capodanno D
        • Conradi L
        • de Bonis M
        • de Paulis R
        • Delgado V
        • Freemantle N
        • Gilard M
        • Haugaa KH
        • Jeppsson A
        • Jüni P
        • Pierard L
        • Prendergast BD
        • Sádaba JR
        • Tribouilloy C
        • Wojakowski W
        ESC/EACTS Scientific Document Group. 2021 ESC/EACTS Guidelines for the management of valvular heart disease.
        Eur Heart J. 2022; 43: 561-632
        • Baekke PS
        • Jørgensen TH
        • Søndergaard L.
        Impact of early hospital discharge on clinical outcomes after transcatheter aortic valve implantation.
        Catheter Cardiovasc Interv. 2021; 98: E282-E290
        • Okoh AK
        • Siddiqui E
        • Soto C
        • Dhaduk N
        • Hirji S
        • Tayal R
        • Chen C
        • Lee LY
        • Russo MJ.
        Trends in early discharge and associated costs after transcatheter aortic valve replacement: A national perspective.
        Innovations (Phila). 2021; 16: 373-378
        • Lauck SB
        • Wood DA
        • Baumbusch J
        • Kwon JY
        • Stub D
        • Achtem L
        • Blanke P
        • Boone RH
        • Cheung A
        • Dvir D
        • Gibson JA
        • Lee B
        • Leipsic J
        • Moss R
        • Perlman G
        • Polderman J
        • Ramanathan K
        • Ye J
        • Webb JG.
        Vancouver transcatheter aortic valve replacement clinical pathway: minimalist approach, standardized care, and discharge criteria to reduce length of stay.
        Circ Cardiovasc Qual Outcomes. 2016; 9: 312-321
        • Généreux P
        • Piazza N
        • Alu MC
        • Nazif T
        • Hahn RT
        • Pibarot P
        • Bax JJ
        • Leipsic JA
        • Blanke P
        • Blackstone EH
        • Finn MT
        • Kapadia S
        • Linke A
        • Mack MJ
        • Makkar R
        • Mehran R
        • Popma JJ
        • Reardon M
        • Rodes-Cabau J
        • Van Mieghem NM
        • Webb JG
        • Cohen DJ
        • Leon MB
        • VARC-3 Writing Committee
        Valve Academic Research Consortium 3: Updated endpoint definitions for aortic valve clinical research.
        J Am Coll Cardiol. 2021; 77: 2717-2746
        • Austin PC.
        An introduction to propensity score methods for reducing the effects of confounding in observational studies.
        Multivariate Behav Res. 2011; 46: 399-424
        • Barbanti M
        • van Mourik MS
        • Spence MS
        • Iacovelli F
        • Martinelli GL
        • Muir DF
        • Saia F
        • Bortone AS
        • Densem CG
        • van der Kley F
        • Bramlage P
        • Vis M
        • Tamburino C.
        Optimising patient discharge management after transfemoral transcatheter aortic valve implantation: the multicentre European FAST-TAVI trial.
        EuroIntervention. 2019; 15: 147-154
        • Thiele H
        • Kurz T
        • Feistritzer HJ
        • Stachel G
        • Hartung P
        • Lurz P
        • Eitel I
        • Marquetand C
        • Nef H
        • Doerr O
        • Vigelius-Rauch U
        • Lauten A
        • Landmesser U
        • Treskatsch S
        • Abdel-Wahab M
        • Sandri M
        • Holzhey D
        • Borger M
        • Ender J
        • Ince H
        • Öner A
        • Meyer-Saraei R
        • Hambrecht R
        • Fach A
        • Augenstein T
        • Frey N
        • König IR
        • Vonthein R
        • Rückert Y
        • Funkat AK
        • Desch S
        • Berggreen AE
        • Heringlake M
        • de Waha-Thiele S
        • SOLVE-TAVI Investigators
        General versus local anesthesia with conscious sedation in transcatheter aortic valve implantation: the randomized SOLVE-TAVI trial.
        Circulation. 2020; 142: 1437-1447
        • Noad RL
        • Johnston N
        • McKinley A
        • Dougherty M
        • Nzewi OC
        • Jeganathan R
        • Manoharan G
        • Spence MS.
        A pathway to earlier discharge following TAVI: assessment of safety and resource utilization.
        Catheter Cardiovasc Interv. 2016; 87: 134-142
        • Lum MY
        • Wang SX
        • Wisneski AD
        • Liang NE
        • Zimmet J
        • Shunk KA
        • Stechert M
        • London MJ
        • Ge L
        • Tseng EE.
        Development of the minimalist approach for transcatheter aortic valve replacement at a Veterans Affairs Medical Center.
        J Invasive Cardiol. 2021; 33: E108-E114
        • Toppen W
        • Johansen D
        • Sareh S
        • Fernandez J
        • Satou N
        • Patel KD
        • Kwon M
        • Suh W
        • Aksoy O
        • Shemin RJ
        • Benharash P.
        Improved costs and outcomes with conscious sedation vs general anesthesia in TAVR patients: time to wake up?.
        PLoS One. 2017; 12e0173777
        • Villablanca PA
        • Mohananey D
        • Nikolic K
        • Bangalore S
        • Slovut DP
        • Mathew V
        • Thourani VH
        • Rode's-Cabau J
        • Núñez-Gil IJ
        • Shah T
        • Gupta T
        • Briceno DF
        • Garcia MJ
        • Gutsche JT
        • Augoustides JG
        • Ramakrishna H.
        Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: a meta-analysis.
        Catheter Cardiovasc Interv. 2018; 91: 330-342